Abstract 15895: Durability of Linear Ablation Lesions and Their Relationship With Clinical Recurrence After Left Atrial Catheter Ablation in Patients With Persistent Atrial Fibrillation: Focused on Redo-Ablation Findings
Introduction: Linear ablation of left atrium (LA) mimicking catheter maze procedure has been known to be effective rhythm control strategy in persistent atrial fibrillation (AF). So we explored the bidirectional block (BDB) rate for LA ablations in de novo procedure and redo-procedure and compared their clinical outcomes.
Methods: Among 1338 consecutive patients in Yonsei AF ablation Cohort, we included 236 patients with persistent AF (78.4% male, 58.7±10.7 years old) who underwent catheter ablation with consistent ablation protocol of circumferential pulmonary vein isolation (CPVI), cavotricuspid isthmus ablation (CTI), roof line (RL), posterior inferior line (PIL), and anterior line (AL). BDBs were checked in all LA ablation lesions in de novo and redo-ablations.
Results: 1. In the de novo ablation procedure, BDB rates were 100% in CPVI, 100% in CTI, 92.3% in RL, 51.6% in PIL, and 76.4% in AL. In 72.4% of the patients, complete BDBs were achieved in all LA ablation lesions. 2. During 12.3±8.4 months follow-up, clinical recurrence rate was 17%, and it was not significantly different between complete BDB group (19%) and partial BDB group (13%, p=0.690). However, recurrence pattern was more likely as paroxysmal form in complete BDB group (21.1%) compared with partial BDB group (4.3%, p=0.013). 3. We conducted redo-procedure in 34 patients (14.4%) and the maintenance of previously achieved BDB were 42.5% in CPVI, 75.0% in CTI, 70.5% in RL, 46.8% in PIL, and 36.6% in AL. 4. Clinically mappable atrial tachycardia (AT) was documented in 11 patients (32.4% of redo), and 3 of them were terminated at anterior line (2) or LA appendage (1). Non-PV triggers were ablated in 9 patients (26.4%); at coronary sinus ostium (4), septum (2), low right atrium (2), and superior vena cava (1) 5. After redo-procedure, complete BDB rate in redo-procedure was 74%, and 22% of them recurred again during 10.0±6.9 months follow-up.
Conclusion: Durability of complete BDB was relatively low in patients who underwent redo-procedure, and reconnected BDB might be the main mechanism of recurrence after catheter ablation for persistent AF. We need to look for more efficient technology to achieve complete and permanent conduction block to improve clinical outcome of AF ablation for persistent AF.
Author Disclosures: J. Park: None. T. Kim: None. J. Park: None. J. Uhm: None. J. Kim: None. B. Joung: None. M. Lee: None. C. Hwang: None. H. Pak: None.
- © 2014 by American Heart Association, Inc.